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Pausing a patient's usual dose of blood pressure medication on the day of surgery reduces the rate of very low blood pressure requiring treatment during the operation compared with taking their medication as normal, finds a trial of older adults, published by The BMJ. The researchers say this simple strategy "provides high-certainty evidence supporting omission of the morning dose in this population."

Around one-third of surgical procedures worldwide involve patients aged 60 years or older, many of whom take daily blood pressure–lowering drugs (antihypertensives). However, older adults are prone to low blood pressure (hypotension) during surgery, which can lead to acute kidney injury, heart attack and death.

Some studies have shown that pausing antihypertensives two to three days before surgery reduces the risk of hypotension, whereas others have found no difference, and clinical guidelines provide only weak recommendations on this topic.

To address this uncertainty, researchers carried out a trial to test the effects of skipping two commonly prescribed antihypertensives—angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs)—on the morning of noncardiac surgery on rates of hypotension during surgery.

Their findings are based on 2,012 patients aged 60 to 80 years (average age 69; 54% male) with high blood pressure who had taken ACE or ARB tablets for an average of 10 years and were undergoing noncardiac surgery under general anesthesia at five large Chinese hospitals between November 2020 and December 2023.

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